Provider Demographics
NPI:1497937338
Name:ROBERTO PEREZ-MILLAN, MD, P.A
Entity Type:Organization
Organization Name:ROBERTO PEREZ-MILLAN, MD, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-MILLAN, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-873-2800
Mailing Address - Street 1:4600 N. HABANA
Mailing Address - Street 2:SUITE 28
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7123
Mailing Address - Country:US
Mailing Address - Phone:813-873-2800
Mailing Address - Fax:813-873-2811
Practice Address - Street 1:4600 N. HABANA
Practice Address - Street 2:SUITE 28
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7123
Practice Address - Country:US
Practice Address - Phone:813-873-2800
Practice Address - Fax:813-873-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88669208100000X, 2081P2900X
ME88669208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272664500Medicaid
FLI29696Medicare UPIN
FL272664500Medicaid
FLU4785YMedicare UPIN
FL6263850001Medicare NSC